How many Deaths is an elected official allowed before he/she is assigned an accurate but less than complimentary Nom De Plume which reflects his/her accomplishment ? If you are Ron DeSantis of Florida the number is probably zero. However, If you are Andrew Cuomo , the number is in the thousands.
The exact number may never be known since the quality of the recordkeeping and reporting is suspect – but published reports of the effect of the his now infamous March 25, 2021 order, put the number into the thousands. For those who don’t remember, Gov. Cuomo ordered Nursing homes to accept, without testing, medically stable patients without regard as to their COVID 19 status. Nursing homes were specifically prohibited from requiring testing of a hospitalized resident determined to be medically stable.
The stated reason for this policy was the urgent need for hospital beds, yet , the Javits Center opened with a 1,000 bed capacity two days after the order was issued. The USNS Comfort , with an additional 1,000 beds arrived March 30. It left New York waters on April 30 having cared for 282 patients, less than 30% of it’s capacity. Yet the order stayed on.
The Javits center closed on May 8, 2020. The order requiring Nursing Homes to take COVID 19 positive patients remained in place until May 27, 2020 after NY had registered one of if not the highest death rate in the Nation.
Now many are suggesting that Gov. Cuomo be investigated for attempting to cover-up his handling of the news concerning his lethal order.
The time is overdue for Mr. Cuomo to receive a Nom De Plum worthy of his actions. Henceforth he shall be known as The Butcher of Albany.
Serious consideration should be given to criminal prosecution for the untold number of persons who died because of his infamous order. Their cries for justice are deafening.
The number of new COVID infections is declining rapidly, suggesting to some that the novel coronavirus pandemic may be on the verge of ending. Nevertheless, even with the advent vaccines that apparently prevent its transmission from person to person, most Americans believe the protective measures adopted over the last year like mandatory masking will continue for some time.
A recent Rasmussen Reports poll found that nearly three out of every four Americans over the age of 18 expect the requirement that masks be worn outdoors will remain in place for at least another six months. Almost a third – 36 percent – said it would be more than 18 months before it would be acceptable to be barefaced in public once again.
“It’s an indictment of the media that so many people expect mask mandates to persist for months,” said the Committee for Prosperity’s Phil Kerpen who has for months been crunching the numbers related to the pandemic and its spread.
Kerpen and his group produce a free daily hotline that provides short and timely insider updates on what is happening with the economy and the virus. It was one of the first to notice that New York’s Democratic Gov. Andrew Cuomo seemed to be fudging the numbers connected to COVID-19 in nursing homes, a story most news outlets missed.
With Vice President Kamala Harris and others inside the Biden Administration claiming, falsely, that they’ve had to begin the fight against the coronavirus “from scratch,” the recent acknowledgment by Dr. Rochelle Walensky, the director of the U.S. Centers for Disease Control and Prevention that the number of new cases and hospitalizations are indeed coming down.
“We continue to see a five-week decline in COVID cases, with cases decreasing 69 percent in the seven-day average since hitting a peak on January 11th. The current seven-day average of approximately 77,000 cases is the lowest recorded since the end of October,” Dr. Walensky said during a White House briefing Friday.
“Like new COVID-19 cases, the number of new hospital admissions continues to drop. The seven-day average of new admissions on February 16th, approximately 7,200, represents a 56 percent decline since the January 9th peak,” the doctor continued.
The problem remains what to do until what many medicos refer to as “herd immunity” is reached. Some, like Biden COVID advisor Dr. Anthony Fauci, have suggested it may be prudent to double up on masks while the CDC’s latest recommendation is “placing a sleeve made of sheer nylon hosiery material around the neck and pulling it up over either a cloth or medical procedure mask.” Others, like Kerpen, suggest the best possible thing would be for states to open up and for people to be allowed to go about their business once again, and for children to be permitted to return to school on a five-day-per-week schedule.
“More governors need to exercise the leadership of Florida’s Ron DeSantis, the Dakota’s Kristi Noem and Doug Burgum, and Kim Reynolds of Iowa and proclaim a return to normal now – now, forever, months in the future,” Kerpen said.
His suggested approach appears to be the wise one. Recent comparisons of the spread of COVID-19 in Florida and California show little difference in how things have turned out. This would seem to deflate the dire predictions Gov. DeSantis’s decision to re-open the economy in the nation’s third most populous state would push the number of infections and death off the charts.
None of that seems to have happened. What is different is that Florida’s been open for business for some time while California’s economy, which for months has been in a lockdown state, is floundering badly. The performance of the two economies, which are about as different at this point as night and day, are worth further study. There may be valuable clues regarding the best ways to fight a pandemic hidden in the data, waiting to be unmasked.
Last year, 621 people died of drug overdoses in San Francisco. To put this in perspective, 173 people died from COVID-19, which is identified as the primary public health crisis in the Bay Area.
For years, San Francisco has tacitly encouraged drug abuse with remarkably lenient policies, and those policies are now inadvertently killing hundreds of people annually. San Francisco uses a policy approach called “harm reduction,” which stresses “culturally competent, non-judgmental treatment that demonstrates respect and dignity for the individual.”
But this approach, as it is practiced within San Francisco, is inhumane and cruel. It is destroying the dignity of the lives that some could have with more sensible policies. In addition to overdose deaths skyrocketing, drug abuse has increased in San Francisco, and it is becoming more difficult for addicts to affect positive change.
If you spend much time in San Francisco, you know this, as several areas of the city have become de facto open-air drug bazaars, with drug abuse and drug sales taking place for all to see. Harm-reduction policies are expanding drug use among youths through the dispensation to homeless adolescents of “safe snorting kits” and “safe smoking kits” for crack use. As if any crack use could be considered “safe.”
There are an estimated 25,000 drug users in San Francisco, which if anything is too low of a count since that estimate is nearly two years old. This exceeds San Francisco’s high school population by more than 50 percent and works out to about 522 drug users per city block. Sadly, thousands of human tragedies unfold every day, eviscerating those who use drugs, and forever affecting the lives of those who see it daily, including many children.
Drug abuse is challenging to treat, but a recent handbook of best practices for substance abuse treatment by the Department of Health and Human Services shows that targeted treatment can be very effective, particularly when intervention occurs early.
But a drawback to San Francisco’s acceptance and facilitation of drug use is that it prevents early intervention. Unless San Francisco completely changes how it views drug abuse, these numbers will become even worse. The country’s most progressive city needs to understand that their policies are creating implicit death sentences for many who could be helped with a different policy approach.
Understanding this begins with the simple economics about drug use, which highlights why harm reduction has failed. On the demand side, drug users come to San Francisco from elsewhere because they know the city tolerates and facilitates drug use, which includes providing free hypodermic needles. While giving away nearly 5 million clean needles annually (which boils down to nearly 6 needles for every San Franciscan) admirably reduces communicable diseases, it has created a public health hazard, because about two million used needles are disposed of on city sidewalks. Over $30 million has been spent on dealing with drug abuse within the public transit system, but one could hardly tell this by viewing transit stations that anything has been done to deal with this issue.
On the supply side, selling drugs in San Francisco has become extremely profitable, given a demand side of 25,000 consumers and the city’s tolerant policies. In contrast to most other cities, the drug trade in San Francisco operates within what is almost a normal marketplace setting, where buyers and sellers can find each other easily, and with a relatively small chance of being arrested. Both of these factors promote relatively low prices, which stimulate demand, and high profits, which stimulate supply.
By normalizing drug abuse, San Francisco has created a perfect storm of a vibrant, well-functioning market of buyers and sellers who trade drugs much like a basket of fruit is traded at a farmer’s market. Unfortunately, the basket that is being traded in San Francisco’s drug bazaar is increasingly becoming the opioid Fentanyl, which can be 100 times more powerful than morphine.
Fentanyl is sufficiently strong that much less than one milligram is used as general anesthesia during major surgery. Just two milligrams—the equivalent of about 25 grains of sand—can be lethal. Emergency personnel responding to a Fentanyl overdose must take precautions so that they do not accidentally inhale Fentanyl. And yet Fentanyl is now being widely traded every day in San Francisco, driving up overdose deaths to about two daily.
What to do? Drug addiction can be treated medically and compassionately without viewing it as part of normal, everyday life, which is what is being practiced today in San Francisco. The city currently allocates over $5 billion to community health and human welfare.
Surely those budgets can be repurposed to treat drug abuse using best practices as outlined by the Department of Health and Human Services in conjunction with greater efforts to identify family members who can assist with treatment and support. At the same time, the city must reduce the amount of Fentanyl and other lethal drugs that are being sold routinely in open-air markets.
Many of San Francisco’s drug users have lost control over their lives. The last thing that drug addicts need is another drug pusher, but this is what San Francisco’s policies have created. Lives can be saved, but not unless policies are changed.
Large unexpected expenses are never welcome. No one likes a costly surprise. That may explain why Congress is talking about government imposing a “fix” to “protect” patients from surprise medical bills.
That may sound good, but healthy skepticism is warranted. One only needs to remember how the Obama-Biden administration repeatedly promised to save us all thousands of dollars every year and allow us to keep our health insurance and our doctor. None of that turned out to be true.
We need a solution to surprise medical bills that rescues consumers from being caught in between the doctor’s or hospital’s bill and the insurance company’s refusal to pay it. But we also need a solution that empowers consumers, not government bureaucrats, and that promotes innovation and harnesses the power of the marketplace to ensure high quality care at the lowest prices.
We must be 100% sure that we avoid government mandated procedures that effectively impose price controls because they also reduce the likelihood of future healthcare innovations and slow the development of promising medicines and procedures. Government mandates almost invariably shift power to government bureaucrats and health insurance companies, rather than giving consumers more control over their own healthcare.
The most common cause of a surprise medical bill is when a person uses a healthcare provider that is not in their insurance plan’s network of providers. While it doesn’t happen often, it is a real challenge for consumers when it does happen. Insurance companies have contracts with healthcare providers to provide medical services at discounted rates. That makes them “in-network.” The “out-of-network” providers charge a price without any pre-negotiated discounted rates. The problem arises when consumers get stuck between the insurance company that doesn’t want to pay and the doctor who should be paid.
The best way to solve the nation’s surprise medical bill problem is to implement a fair and open independent dispute resolution (IDR) process. A fair IDR process simply means that both sides of the out-of-network bill dispute, the physician and the health insurer, are allowed to submit all relevant information to make their case. Then the arbitrator or decision-maker can weigh the evidence and provide a fact specific resolution to what the insurance company should pay and what the doctor should accept.
This would relieve the patient of worrying about the bill, and it would make sure that difficult or complex medical procedures and treatments don’t become devalued or more difficult to find.
Sens. Lamar Alexander and Bill Cassidy are rumored to be working on a “compromise” that purports to use a form of IDR. But we should be on high alert because all indications are that the “compromise” will include a rigged or sham IDR process that puts the heavy hand of government on one side of the scales of fairness and justice. There is no reason to use a process that from the start tips the scales in favor of either the doctor or the insurance company.
This “compromise” will favor insurance companies over doctors. If the government-imposed process ends up being a price control system, it will simply be a step toward socialized medicine and will make finding doctors to treat you more difficult. What we should all want is a fair and balanced process.
A fair and impartial IDR process that resolves the pricing dispute would prevent the consumer from getting caught in the middle. It would also empower consumers, not government.
Additionally, it would harness the power of the marketplace to keep quality up and prices down. It is important to remember that government regulations don’t have a track record of reducing costs. Moreover, government mandates will do nothing to reward innovation, or to empower consumers.
Regardless of what their true motives were or are, the results we have witnessed in the last 50 years from politicians promising “fixes” has been that things end up costing a lot more than promised, and government gets more and more control. Those who can afford lobbying efforts may escape the costly impact of these government mandates. But rarely do these promised fixes on balance help the average citizen.
Instead of continuing to empower government, insurance companies, and those who can afford lobbyists to protect their interests, let’s try reforms that put economic power back in the hands of healthcare consumers. Let’s trust the marketplace to do what it does so well — boost quality and keep prices comparatively low. We trust the marketplace to provide us with food, housing, technology, and thousands of other very important things. Why not our healthcare, as well?
We can do all of this with a fair and balanced IDR process that allows both sides of the out-of-network bill dispute to submit all relevant information to make their case. If this happens, we protect consumers from surprise medical bills and we keep burdensome government mandates out of our healthcare choices. That’s a win-win!
“Saturday Night Live” is known for many things, especially the commercial spoofs that for decades have lampooned merchandise and marketing trends. One of the most iconic featured Chevy Chase as a pitchman hawking a product that was both “a dessert topping and a floor wax.”
That kind of absurd duality is funny. That kind of duality in a political group is dangerous and calls into question the advocacy in which they engage.
Everyone thinks AARP, the group formerly known as the American Association of Retired Persons, represents the interests of millions of seniors, making it one of the most powerful lobbying groups in Washington. People don’t realize it’s also an insurance company and rakes in hundreds of millions selling Medigap coverage to its members.
Which interest is dominant: the commercial or the political? Given the group’s influence on important issues like healthcare, it’s a fair question. A recently released Juniper Research Group report suggests commercial concerns now may override in importance the lifestyle and economic issues on which AARP made its name.
Citing several sources, the report says that although AARP members contacting the group’s headquarters opposed the Affordable Care Act by a margin of 14 to 1, it went ahead and backed the bill anyway. Could that be because its insurance company partner – UnitedHealth – was more interested in getting a law on the books requiring every American to purchase health insurance than what its members wanted?
The report, available at www.CommitmentToSeniors.org and compiled for the group American Commitment, says the money coming from the purchase of supplemental health insurance coverage is now AARP’s main revenue source. However, rather than helping seniors select a plan tailored to their needs or financial resources, the group sells UnitedHealth insurance exclusively in return for a 4.95% cut on every plan sold.
This relationship brought more than $600 million into AARP’s coffers in 2017. Some might see that as evidence the group has evolved into a marketing vehicle for the nation’s largest health insurer. Several ongoing lawsuits contest that the money flowing to the group from its deal with UnitedHealth constitutes an “illegal kickback” because the potential customers are told the policies are cheaper than what’s available in the marketplace when identical coverage can be obtained without paying AARP’s commission.
Many of the same politicians who criticized the health insurance industry and other corporate interests as being selfish during the debate over Obamacare nonetheless hang on every word issuing from AARP headquarters. Obviously, they’ve failed to ask themselves if the group is speaking for its members or its funders.
American needs healthcare reform. Obamacare distorted the system in all kinds of ways. It made it difficult to keep the doctors we like and to utilize the insurance we bought because deductibles have risen so much. If we’re going to have an honest discussion about how to get out of the mess we’re in, the key players need to show their cards – or have them shown for them.
The elite media and so-called good government groups keep a close eye out for conflicts of interest, both real and potential, in the advocacy community on the right.
They argue against the influence of so-called “dark money” on all kinds of issues, not just healthcare. The watchdog groups who like to tie groups that question the existence and impact of climate change to oil companies and supporters of the Second Amendment to gun manufacturers seem to have missed the link between United Health and AARP.
Maybe they just don’t want to see it.
If all you did was listen to the politicians and commentators, you’d think America’s health care system was on the verge of collapse. Nothing could be further from the truth. There are problems, but most of them have been caused by the self-same reformers who’ve been trying for more than two decades to “fix” it.
Much progress has been made since the New York Times and presidential candidate Bill Clinton declared a crisis existed and proposed solving it by increasing the role played by the government in managing the delivery of services and prices. Once the voters learned the potential adverse impacts on the quality of care they received, the debate changed.
Through it all, America has continued providing the best care anywhere. The spirit of invention and innovation that is the hallmark of our civilization exists robustly in the health care sector and, because it does, people are living longer, generally healthier lives. Yet, instead of encouraging that, scholars and policymakers continue to focus on flattening the cost curve through fiat. Price controls and rationing may reduce the perceived costs of medical care but won’t solve the problem.
The real solutions will come from innovations in care. That means continuing the development of radical new treatments that were unthinkable a generation ago and, in a few cases, going back to what was working before the government messed things up.
One place where looking back is already helping us move forward is kidney dialysis. In 1972, thinking they were helping, Congress passed legislation creating a Medicare program to pay for dialysis treatment and patients with end-stage renal disease gravitated to more expensive, center-based care using machines built for use in centers that are large, hard-to-use, and too expensive for home use.
In 1973, 40 percent of dialysis patients received treatment at home. Today, 90 percent receive treatment at dialysis centers and hospitals — at much greater cost and at greater risk to their health because the entire time they are there, checking in, checking out, waiting for and receiving treatment, they’re in the company of others who might be sick with something like COVID-19 that science tells us preys on those whose immune systems are compromised.
We spend more than $110 billion on kidney disease, the ninth leading cause of death in the United States. More than 37 million Americans have some form of this disease and the money paying for their dialysis comes from Uncle Sam through Medicare. That’s not sustainable.
The alternative to spending more is to spend smarter. The Trump Administration, which earlier this year announced a plan to “shake up” the kidney care medical complex is pushing for a return to home-based hemodialysis as a cost-saving measure and one more in line with patient concerns. His executive order on the issue included a direction to the Department of Health and Human Services to develop policies to reduce the number of Americans getting dialysis treatment at dialysis centers.
That’s the right move. The in-home care alternative will have the biggest impact in the shortest amount of time. The current care cycle, where treatment begins when it’s too late to stop disease progression. Must be broken. Instead of throwing more money at dialysis clinics, the priority is being repurposed in the right place, on early diagnosis, better patient education, and comprehensive and holistic care services.
Home-based options for hemodialysis, where blood is pumped out of the body under supervision into a machine that acts as a kidney and filters the blood before returning it to the body, and peritoneal dialysis, where blood vessels in the lining of the belly filter the blood with the help of a cleansing fluid, exist and should be utilized to the fullest extent possible.
Starting in 2021, ESRD patients will also be able to enroll in Medicare Advantage plans – great for the ESRD patients, but it could increase premiums for all seniors if we don’t help these plans negotiate for fair rates and prevent costs from rising. The Centers for Medicare and Medicaid Services should remove any roadblocks that exist to making this option viable.
With COVID-19 is changing how people go about their lives, the incentive to adapt and innovate in the health care sector is there. Telehealth, which was generally frowned upon before the current crisis, has taken off like a moonshot. Changing the kidney dialysis model to one where the care is mostly provided at home could liberate those receiving treatment now held prisoner by their illness and could lead the transformation of American medicine. Anyway, it’s worth a try.
Editor’s Note: This is an edited excerpt, comprising the Introduction and Conclusion, from a longer essay by Mr. Atlas. Titled ‘The Costs Of Regulation And Centralization In Health Care,' it is published by the Hoover Institution as part of a new initiative, "Socialism and Free-Market Capitalism: The Human Prosperity Project."
The overall goal of US health care reform is to broaden access for all Americans to high-quality medical care at lower cost. In response to a large uninsured population and increasing health care costs, the Affordable Care Act (ACA, or “Obamacare”) aimed first and foremost to increase the percentage of Americans with health insurance. It did so by broadening government insurance eligibility, adding extensive regulations and subsidies to health care delivery and payment, and imposing dozens of new taxes. The ACA was projected to spend approximately $2 trillion over the first decade on its two central components: expanding government insurance and subsidizing heavily regulated private insurance.
Through its extensive regulations on private insurance, including coverage mandates, payout requirements, co-payment limits, premium subsidies, and restrictions on medical savings accounts, the ACA counterproductively encouraged more widespread adoption of bloated insurance and furthered the construct that insurance should minimize out-of-pocket payment for all medical care. Patients in such plans do not perceive themselves as paying for these services, and neither do physicians and other providers. Because patients have little incentive to consider value, prices as well as quality indicators, such as doctor qualifications or hospital experience, remain invisible, and providers do not need to compete. The natural results are overuse of health care services and unrestrained costs.
In response to the failures of the ACA, superimposed on decades of misguided incentives in the system and the considerable health care challenges facing the country, US voters at the time of this writing are being presented with two fundamentally different visions of health care reform: (1) a single-payer, government-centralized system, including Medicare for All, the extreme model of government regulation and authority over health care and insurance, which is intended to broaden health care availability to everyone while eliminating patient concern for price; or (2) a competitive, consumer-driven system based on removing regulations that shield patients from considering price, increasing competition among providers, and empowering patients with control of the money. This model is intended to incentivize patients to consider price and value, in order to reduce the costs of medical care while enhancing its value, thereby providing broader availability of high-quality care.
Outside a discussion of the role of private versus public health insurance are two realities. First, America’s main government insurance programs, Medicare and Medicaid, are already unsustainable without reforms. The 2019 Medicare Trustees report projects that the Hospitalization Insurance Trust Fund will face depletion in 2026. Most hospitals, nursing facilities, and in-home providers lose money per Medicare patient. Dire warnings about the closure of hospitals and care provider practices are already projected by the Centers for Medicare and Medicaid due to the continued payment for services by government insurance below the cost of delivery of those services. Regardless of trust fund depletion, Medicare and Medicaid must compete with other spending in the federal budget. America’s national health expenditures now total more than $3.8 trillion per year, or 17.8 percent of gross domestic product (GDP), and they are projected to reach 19.4 percent of GDP by 2027. In 1965, at the start of Medicare, workers paying taxes for the program numbered 4.6 per beneficiary; that number will decline to 2.3 in 2030 with the aging of the baby boomer generation. Unless the current system is reformed, federal expenditures for health care and social security are projected to consume all federal revenues by 2049, eliminating the capacity for national defense, interest on the national debt, or any other domestic program.
Second, beyond the growing burden from lifestyle-induced diseases, including obesity and smoking, that will require medical care at an unprecedented level, America’s aging population means more heart disease, cancer, stroke, and dementia—diseases that depend most on specialists, complex technology, and innovative drugs for diagnosis and treatment. The current trajectory of the system is fiscally unsustainable, and millions are already excluded from the excellence of America’s medical care.
In most nations, heavy regulation of the supply of health care goods and services care is coupled with marked centralization of payment for medical care. The United States has a far less centralized but still highly regulated system in which health expenditures are roughly equal from public and private insurance. The system is characterized by its unique private components: more than 200 million Americans, including most seniors on Medicare, use private insurance. The US system is the world’s most effective by literature-based, objective measures of access, quality, and innovation, but US health care demands reform. Health care costs are high and increasing, and the projected demand for medical care by an aging population and the future burden of lifestyle-related disease threaten the sustainability of the system.
Although the regulatory expansion under the Affordable Care Act reduced the uninsured population, it generated increased private insurance premiums, a withdrawal of insurers from the market, and sector-wide consolidation that is historically associated with higher prices and reduced choices of medical care. In its wake, American voters are now presented with two fundamentally different visions for reform that have a diametrically opposed reliance on regulation and centralization: (1) the Democrats’ single-payer proposals, including Medicare-for-All, based on the most extreme level of government regulation and authority over health care and health insurance; or (2) the Trump administration’s consumer-driven system that relies on strategic deregulation to increase market-based competition among providers and empowering patients with control of the money. Both pathways are intended to contain overall expenditures on health care and broaden access.
Intuitively, a single-payer model of health care represents a simplification, but the reality is that such centralized systems impose overwhelming restrictions on both demand and supply. Government-centralized single-payer systems actively hold down health care expenditures mainly by sweeping restrictions on the utilization and payment for medical procedures, drugs, and technology under the single authority of the central government. The overall costs of this false simplification are enormous, creating societal costs that extend beyond calculated tax payments that are required to support such a system.
The alternative approach involves rule elimination and decentralization, that is, strategic deregulation, to induce competition for value-seeking patients. Reducing the price of health care by competition, instead of more regulation, generates lower insurance premiums, reduces outlays from government programs, and broadens access to quality care. Broadly available options for cheaper, high-deductible coverage less burdened by regulations; markedly expanded health savings accounts; and tax reforms to unleash consumer power are keys to achieving price sensitivity for health care. Reforms to increase the supply of medical care by breaking down long-standing anti-consumer barriers to competition, such as archaic certificates‐of‐need for technology, unnecessary state‐based licensure of physicians, and overly regulated pathways to drug development, while facilitating transparency of price and quality among doctors and hospitals, would generate further competition and reduce the price of health care. Preliminary results from such deregulatory actions demonstrate promising results and offer an evidence-based context for the broader discussion of the role and reach of government regulation in socialism compared with free-market systems.
A lot to argue about!
Trump held his first post-lockdown rally last evening in Tulsa, Oklahoma. There was controversy before, during and after the event. Criticism was not confined to the content of the speech as usual but spread over the unusual areas of the timing, location, venue, and attendance of the rally.
The earliest criticism concerned the timing of the event. A Trump rally, held in an indoor arena, was criticized as a blatant violation of the CDC current (and often changing) recommendations regarding safeguards against the “Chinese virus”, as Trump calls it. Among the most obvious violations were the lack of social distancing in the densely packed house, without compulsory masks, and held indoors (as opposed to outdoors).
After the rally, much was made of the lower attendance. Not only were there noticeable empty bleachers (which the network cameras showed frequently), but also the scheduled outdoor appearance by the President was cancelled because the only crowd out there was the ever-present (thankfully peaceful) protesters. Nevertheless, there were approximately 18,000 or more in attendance, counting the seating on the floor of the arena, out of a published capacity of 19,000. One unaccounted-for factor was the absence of the 0ver-65 crowd who tend to be among the most loyal of the Trump base.
So, what to think about all this? First of all, there is the symbolic significance of the scheduling. The President has shown in various ways that the public health contingent – which essentially scared him (and all of us) into the lock-down in the first place – is no longer calling the shots in the White House response to the pandemic.
This column remarked very early in the process the fact that the public health perspective is necessarily limited. Never before in American history has this group been given such control over public policy. At the first sign of a public health threat, Mr. Trump, in typical CEO practice, called into service the finest experts he could find in this field – which he admitted was far from his own experience. He then followed their advice, quite uncritically. As I pointed out at the time, this was a huge gamble: if it went wrong, it could, among other things, cost him the election and even his place in history. (See https://drlarryonline.com/trumps-huge-gamble/)
After a while, he did begin to appreciate the narrowness of that perspective. But he was stuck in the middle of a lock-down which he had ordered! Thus, began the journey back to recovery, to normalcy. His diffusion of power to local politicians was a stroke of genius. Not only did he gradually shed the sole responsibility for the lock-down, but he made friends and evoked loyalties among an entire new group of politicians with whom he had had little prior contact. And it was acting out the essence of the Constitution, which sees the sovereign states as surrendering and thereby validating some of their powers to create the federal government.
This entire scenario was moving along quite nicely. Then two unexpected things happened: the Washington Democrats in Congress began to “adopt” the public health establishment, endorsing ever more stringent limitations on the population in the name of the pandemic. As this attitude began to percolate out to the state governors, the recovery slowed down.
By this time Trump and his people had fully realized that the lock-down had nearly ruined the economy and still threatened to do so. They went into overdrive to speed up the recovery. Trump was still winning, however, until the next shoe dropped: a cellphone video of the brutal murder of a defenseless Black man by a White policeman in Minneapolis went viral on social media. The reaction was a worldwide protest against civil authority in America. After a few peaceful marches, the movement turned violent and radical leadership emerged.
Among other secondary effects, the total attention of America — and much of the world – turned away from the economic recovery and toward the protesters and the rioters.
Some past events of this type have elicited soaring rhetoric from leaders such as the Reverend Martin Luther King, Jr. and Senator Robert Kennedy to begin healing the wounds. Soaring rhetoric is not one of Mr. Trump’s talents. Nor does he have the soothing, compassionate manner of a Bill Clinton or a George Bush. In the face of these disasters, Donald Trump stumbled.
The Democrat opposition immediately made him the face of the disaster. His poll numbers have tumbled, yielding to the reclusive Mr. Biden whose silence has served him well.
Trump may not be a great orator or an instinctive healer, but he does excel at one thing: he can draw thousands of impassioned participants to his rallies. This is his unique sandbox and he felt the urgency to activate it.
The Tulsa Rally was the first step on Trump’s road to recovery. It was an act of defiance to the public health establishment and their new sponsors, the Democrats and the press. It also emphasizes the simple truth that the virus is going to be around for a long time, and we have to learn to live with it while carrying on our normal economic activity. Our financial survival as a nation depends on it.
Whether Trump’s new strategy succeeds or not depends on the next steps. In one of Mr. Trump’s favorite sayings, “We’ll see what happens.”
Indeed, we will.
Unexpected expenses are never welcome and no one likes a costly surprise. So it’s no wonder that there is a lot of talk in Washington and Congress about “protecting” patients from surprise medical bills. Current legislation — SB 1895 — sponsored by Senators Lamar Alexander (R-Tenn) and Patty Murray (D-Wash.) makes such claims. It sounds good until you realize that all the “protecting” talk is just that — talk. Even worse, is that rather than protecting consumers, it will make things worse.
The most common cause of a surprise medical bill is when a person uses a healthcare provider that is not in their insurance plan’s network of providers. While it doesn’t happen that often, it most typically happens in a hospital emergency room — either because the patient is not able to consent to care or because the patient received inaccurate information about insurance coverage.
Insurance companies have contracts with healthcare providers (both doctors and hospitals) to provide medical services at pre-negotiated discounted rates. That makes them “in-network.” The “out-of-network” providers charge a price without any pre-negotiated discounted rates, meaning the out of network costs are greater.
While it is true that most doctors are in most insurance networks and hospitals often have ways to shield their patients from higher costs, there are occasional gaps that remain. And while it is uncommon, it can be costly when it occurs. But despite their rarity, these circumstances are used by politicians to make us think they are proactively solving problems for our benefit. Sadly, they are doing nothing of the sort.
There are a number of proposals currently under consideration in the halls of Congress to fix surprise billing, but they have a couple important things in common. In one-way or another, all of these pieces of legislation entrust the government with the power to set prices. This will impose heavy costs even if executed properly, an idea that is almost laughable given the government’s track record on reducing costs.
This reminds me of the Obama-Biden repeated promise that they had a plan that would save us all thousands of dollars every year and allow us to keep our healthcare plan if that’s what we wanted. Obviously, Obama and Biden failed to deliver on that promise. It was the lie of the year even as judged by liberal fact checkers. Literally, millions of Americans lost their preferred plans and virtually everyone saw their health insurance costs increase, not decrease, by thousands.
So a healthy dose of skepticism about promises to fix surprise billing with government price controls is entirely justified. It should not be enough for politicians to repeat over and over the mantra that they’ve got the fix. We’ve seen this play before. It doesn’t end well.
Government-imposed price controls skew incentives and reduce the availability of quality healthcare. To make things worse, government-imposed price controls also reduce the likelihood of future healthcare innovations and slow the development of promising medicines and procedures. But the bad news doesn’t end there — current proposals shift more and more power to health insurance companies, rather than giving consumers more control over their own healthcare.
Regardless of what their true motives were or are, the results we have witnessed in the last 50 years from politicians promising “fixes” has been that things end up costing a lot more than promised, and government gets more and more control. Those who can afford lobbying efforts may escape the costly impact of these government mandates. But rarely do these promised fixes on balance help the average citizen.
The marketplace — and the negotiations that take place when you have two or more parties all trying to maximize the value that they receive — has a knack for providing high quality goods and services for the lowest possible prices. That is the process that has brought us smart phones that have more computing power than was used in the 1960s in the Apollo program. It’s also the process that allows consumers to own huge flat screen televisions at a cost of several hundred dollars. We need to harness that power and that drive to high quality and low prices in the medical arena.
Instead of continuing to empower government and those who can afford lobbyists to protect their interests, let’s try reforms that put economic power back in the hands of healthcare consumers. Let’s trust the marketplace to do what it does so well — boost quality and keep prices comparatively low. We trust the marketplace to provide us with food, housing, technology, and a thousand other things, why not our healthcare as well?
Today, the average American eats better and spends a lot less to feed themselves than our great grandparents did. As a result, we have access to all manner of foods — something even kings didn’t have a few generations ago. Additionally, we work far fewer hours to obtain that food. As a result, we have more money for larger, more comfortable homes, nice automobiles, vacations, and hospitals — something average Americans in 1776 didn’t even dream about.
So if we want to see more affordable and better quality healthcare available to us all — why not harness the power of the marketplace? Where’s the proof that government-run schemes produce the needed quality and low costs? In contrast, the marketplace has a strong track record. Let’s try it!
Liberals and conservatives are approaching the COVID-19 pandemic through very different moral frameworks.
In a 2008 TED Talk, psychologist Jonathan Haidt said the worst idea in psychology is the notion that humans are born as a “blank slate.”
Like the cognitive psychologist Steven Pinker, Haidt was rejecting the notion that the human mind is a blank slate at birth, an idea that can be traced to thinkers from Aristotle, to John Locke, to B.F. Skinner and beyond.
“Developmental psychology has shown that kids come into the world already knowing so much about the physical and social worlds and programmed to make it really easy for them to learn certain things and hard to learn others,” explained Haidt, a Professor of Ethical Leadership at NYU’s Stern School of Business.
Citing research from the brain scientist Gary Marcus, Haidt said the initial organization of the brain essentially comes with a “first draft.” Studying the anthropological and historical records, Haidt found that five pillars of morality exist across disciplines, cultures, and even species:
What’s interesting is that these moral pillars differ sharply across ideological lines in America today. Haidt found that both conservatives and liberals recognize the harm/care and fairness/reciprocity values (though liberals value these a little more than conservatives). Things change, however, when examining the three remaining foundational values—loyalty/betrayal, authority/subversion, and sanctity/degradation. While conservatives accept these moral values, liberal-minded people tend to reject them.
The difference is extraordinary, and it helps explain the different ways Republicans and Democrats are experiencing the coronavirus. In May, a CNBC/Change Research survey found that while only 39 percent of Republicans said they had serious concerns about COVID-19, 97 percent of Democrats said they had serious concerns.
While some of the divergence could stem from the fact that blue states have been hit harder by COVID-19 than red states, Haidt’s research would suggest that another reason Democrats are more concerned is because liberals have an intense appreciation of the care/harm moral pillar.
Indeed, the preeminence of the care/harm moral can be found in the rhetoric of many progressives.
“I want to be able to say to the people of New York, ‘I did everything we could do,’” New York Gov. Andrew Cuomo announced in March. “And if everything we do saves just one life, I’ll be happy.”
The care/harm moral is even found in the latest social media emojis. Last month, as USA Today reported in an exclusive story, Facebook rolled out its new “care” emoji.
“The new Facebook reaction—an emoji hugging a heart—is intended as shorthand to show caring and solidarity when commenting on a status update, message, photo or video during the coronavirus crisis that allow users to express how much they care about others,” the paper reported.
Cuomo’s language (and to a lesser extent Facebook’s emojis) suggests that, for many, care for others is the preeminent virtue. As such, efforts to protect people must be taken above lesser social considerations.
Understanding the different moral framework conservatives and liberals are using helps us understand why blue states have taken a much more aggressive approach in efforts to limit the spread of COVID-19.
As The Atlantic explains, with a few exceptions, such as Ohio, Republican governors have been much more reluctant to impose sweeping restrictions on their residents than states led by Democratic governors. While governors in these states no doubt value care/harm, their moral framework likely gives them a heightened concern of other social considerations, particularly civil liberties.
The lockdowns, the Constitution Center explains, have threatened many of America’s most cherished civil liberties—the freedom to assemble, the right to purchase a firearm, the ability to freely travel, the freedom to attend church or visit a reproductive health facility. They’ve also put thousands of companies on a path toward bankruptcy by prohibiting them from engaging in commerce.
These infringements tend to be viewed as reasonable to liberals, who emphasize the care/harm moral but are less likely to recognize the sanctity/degradation moral. New Jersey Gov. Phil Murphy, for example, said he never even considered the US Constitution—a document considered sacrosanct by many Americans—when he issued his lockdown order.
“That’s above my pay grade,” Murphy told Tucker Carlson in April. “I wasn’t thinking of the Bill of Rights when we did this. We went to all—first of all—we went to the scientists who said people have to stay away from each other.”
Similarly, Michigan Gov. Gretchen Whitmer saw no problem in suspending the Freedom of Information Act to prevent outside groups from assessing the model state officials used to justify locking down the entire state.
Those who view civil liberties and constitutional rights as sacred, however, are less than comfortable with such an approach. They will be less inclined to sacrifice sacred principles to support sweeping state efforts to protect people (and are probably more likely to see such efforts as counter-productive).
To be sure, some progressives do see civil liberties as sacred, and some of them have expressed dismay and bewilderment that so many progressives, in their enthusiasm for the care/harm moral, have abandoned civil liberties.
“[The COVID-19 crisis is] raising serious civil liberties issues, from prisoners trapped in deadly conditions to profound questions about speech and assembly, the limits to surveillance and snitching, etc.,” the progressive journalist Matt Taibbi recently wrote in Rolling Stone. “If this disease is going to be in our lives for the foreseeable future, that makes it more urgent that we talk about what these rules will be, not less—yet the party I grew up supporting seems to have lost the ability to do so, and I don’t understand why.”
If Haidt’s theory is correct, the reason is liberals and conservatives are, generally speaking, approaching the COVID-19 pandemic through divergent moral frameworks.
After all, the argument isn’t whether we should protect people.
“In any country, the disagreement isn’t over harm and fairness,” Haidt says. “Everyone agrees that harm and fairness matter.”
The argument isn’t even over how to best balance the care/harm moral with other considerations.
The disagreement is over whether efforts to protect individuals from COVID-19 should be balanced against other considerations—including constitutional and economic ones—at all.
ALEXANDRIA, Virginia, June 10 — The 60 Plus Association issued the following letter:
To: President Donald J. Trump, The White House, 1600 Pennsylvania Avenue, NW, Washington, D.C. 20500; The Honorable Alex M. Azar, Secretary, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, D.C. 20201; Vice President Michael R. Pence, The White House, 1600 Pennsylvania Avenue, NW, Washington, D.C. 20500; The Honorable Seema Verma, Administrator, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244; Brooke Rollins, Assistant to the President, Director, Domestic Policy Council, 1600 Pennsylvania Avenue, NW, Washington, D.C. 20500
President Trump, Vice President Pence, Secretary Azar, Administrator Verma, Mrs. Rollins:
On behalf of millions of taxpayers and consumers across the United States, the Coalition Against Rate-Setting (CARS) urges you to oppose price controls on the healthcare system. For the past year, some members of Congress and some individuals in the Trump administration have repeatedly floated the idea of “fixing” the pressing problem of surprise medical billing through a “rate-setting” system. These fatally flawed proposals would have Washington, D.C.bureaucrats dictating to doctors the prices they should charge patients. Recently, Politico reported that the administration is considering a plan that would, “outlaw health care providers from putting patients on the hook for thousands of dollars in expenses — but without mandating how doctors and hospitals would recover their costs from insurers.”
While such reporting gives cause for cautious optimism, we recognize that much remains to be negotiated. As such, the Coalition would like to reiterate that any mandates or price controls would make surprise billing problems worse and disrupt care for millions of patients across the country. These effects would be particularly devastating as the COVID-19 pandemic continues to claim far too many lives. We therefore urge you to reject rate-setting and embrace market-oriented solutions to solve the pressing problem of surprise medical billing.
During the worst public health emergency in our lifetimes, millions of patients across the country have found themselves in emergency rooms and healthcare clinics. Many of them reasonably assumed their troubles would be over after being discharged, only to receive a surprise medical bill in the mail days or even weeks after being discharged.
Each year, 1 in 7 patients in the U.S. receive these unwanted, unexpected expenses after being sent home by their doctors. This devastating problem stems from increasingly narrow health insurance networks which increasingly refuse to compensate attending doctors at in-network medical facilities. Far-reaching pieces of legislation such as the Affordable Care Act (aka Obamacare; signed into law in 2010) have simply made the problem worse, and now, an estimated three-quarters of Obamacare plans feature narrow insurance networks.
Yet, despite federal interventions and regulations making the problem worse, some government officials want to double-down on bureaucratic control over the healthcare system. Members of Congress such as Sen. Lamar Alexander(R-Tenn.) and Rep. Frank Pallone (D-N.J.) have proposed rate-setting for doctors and repeatedly tried to insert this “fix” in Coronavirus-related relief legislation. Officials in the Trump administration have worked hard to get a thorough understanding of this issue and deliberate on their own plan to end unwanted medical expenses. But rate-setting would only make the problem worse, and lead to the widespread consolidation of hospitals, clinics, and doctor’s offices across the country. California has already tried this failed approach, implementing healthcare price controls in 2017. According to a 2019 American Journal of Managed Care study examining the law, rate-setting has led to healthcare facilities closing their doors and merging with other, larger practices. Doctors are even contemplating leaving California altogether.
On January 22, 14 advocacy groups and think-tanks formed CARS to warn lawmakers and the Trump administration about the myriad unintended consequences of rate-setting. CARS is now 34 groups strong, and its work has been cited extensively by national and state media. On April 28, CARS released a letter signed by more than 160 economists urging officials to reject healthcare price-controls.
CARS urges you to take these scholars’ arguments into account, and remain vigilant against federal overreach in the healthcare system. Millions of doctors are on the frontlines of the COVID-19 pandemic treating patients, and now would be the worst possible time to impose onerous price controls on them. Thank you for your time and consideration of this pressing issue.
Tim Andrews, Executive Director Taxpayers Protection Alliance
Christopher Sheeron, President, Action For Health
Bob Carlstrom, President, AMAC Action
Brent Wm. Gardner, Chief Government Affairs Officer, Americans for Prosperity
Norman Singleton, President, Campaign 4 Liberty
Ryan Ellis, President, Center for a Free Economy
Andrew F. Quinlan, President, Center for Freedom and Prosperity
Jeffrey L. Mazzella, President, Center for Individual Freedom
Thomas Schatz, President, Citizens Against Government Waste
Twila Brase, RN, PHN, President & Co-Founder Citizens’ Council for Health Freedom
Matthew Kandrach, President, Consumer Action for a Strong Economy
Jason Pye, Vice President of Legislative Affairs, FreedomWorks
George Landrith, President, Frontiers of Freedom
Saulius “Saul” Anuzis, President, 60 Plus Association
Mario H. Lopez, President, Hispanic Leadership Fund
Andrew Langer, President, Institute For Liberty
Harry C. Alford, Co-Founder, President/CEO, National Black Chamber of Commerce
Pete Sepp, President, National Taxpayers Union
Robert Fellner, Vice President & Policy Director, Nevada Policy Research Institute
Wayne Winegarden, Ph.D, Senior Fellow & Director, Center for Medical Economics and Innovation Pacific Research Institute
Joshua H. Crawford, Interim Executive Director, Pegasus Institute
Renee Amar, Vice President for Policy and Government Affairs, Pelican Institute for Public Policy
Paul Gessing, President, Rio Grande Foundation
Robert Alt, President & CEO, The Buckeye Institute
David McIntosh, President, The Club For Growth
James Taylor, President, The Heartland Institute
James L. Martin, Founder/Chairman, 60 Plus Association
Jessica Anderson, President, Heritage Action For America
Here comes the 'dumb reopening'
Very soon, you and I will have to figure out how to navigate a semi-open America where coronavirus is a terrible fact of life. The lockdowns and stay-at-home orders that state and city governments announced in March are breaking down. This is not red-versus-blue. This is reality. Two weeks ago, Georgia’s Republican governor Brian Kemp faced widespread criticism for his easing of restrictions on business and outdoor activities, even as Colorado’s Democratic governor Jared Polis did the same thing. Now most states are joining in.
In the past few days, California’s Gavin Newsom has said he will begin relaxing parts of his statewide directives, and so has Virginia’s Ralph Northam. Maryland’s Larry Hogan has announced that residents of his state will be able to undergo non-emergency medical procedures and play a round of golf. Newsom, Northam, and Hogan are not the sort of politicians likely to be swayed by a “Lockdown Rebellion” protest. The governors have been led to these decisions by the realization that blanket limitations on individual behavior have done about the best they could do.
States imposed these rules to “bend the curve” of infection so that the medical system did not become overwhelmed. The policy worked, up to a point. New York City, where Ground Zero has taken on another, equally horrible meaning, avoided the nightmare Italian scenario in which doctors had to deny care to some in order to save others. Nationwide, the curve was not so much bent as flattened. The seven-day average of cases and deaths peaked in April. It has since leveled off, and tapered somewhat. Some 1,700 deaths per day for the near future is an awful statistic to contemplate. Especially because other democracies—Taiwan, South Korea, Australia, New Zealand—were able to bring the disease under control.
America is not like them. Three are islands, and the fourth, Korea, is surrounded on three sides by water and on one side by the DMZ. America is also much bigger. We have six times the population of South Korea, and many more times the people of Australia, Taiwan, and New Zealand. We are a more diverse and less cohesive society. Our system of government is designed for inefficiency, to better protect individual liberty. Our bureaucracies show it.
America was unprepared. Unlike the smaller Asian democracies, America did not experience and thus did not learn from the SARS outbreak of 2003. George W. Bush’s 2005 warning was ignored. The sense of invulnerability that comes with living between two oceans, and with allies to the north and south, was once again exposed as an illusion. Leaders at every level of government—federal, state, local—downplayed the threat until it was too late. The desperate circumstances forced us to use the bluntest tool available: shutdown.
The lockdowns were necessary. They were also unsustainable. Americans, so accustomed to freedom, were bound to chafe at being told what to do. Justified fear of coronavirus devastated the food and beverage, travel, hospitality, and entertainment sectors. The economic toll could persist just for so long before it became unbearable. Nor are public health, personal freedom, and economics the only competing values in this emergency. Spiritual life has been harmed. For people living alone, the social and psychological costs of prolonged isolation can be traumatic. For children, extended separation from friends and socializing experiences will have unknown consequences.
The lockdowns are precarious. Therapeutics are in the trial-and-error phase. A vaccine, if one can be found, is many months away. What’s needed is a means of bridging the gap between pandemic and immunity.
The epidemiologists’ preferred strategy is test, trace, and isolate. That is how our fellow democracies suppressed the outbreak. It will be harder for us. The scale of testing required for the plan to work is massive. At the current rate of increase, it will take us months to achieve. There are also supply problems to consider and logistical obstacles to surmount. It’s not a matter of snapping one’s fingers. Frontline medical personnel, for example, continue to identify shortages of personal protective equipment months into the crisis.
Amassing the significant labor force necessary for “contact tracing” might not be too difficult in a time of mass unemployment. What will be harder to overcome are the legitimate worries Americans will have over violations of privacy. Not to mention how they might respond to the techniques of “isolation.” Checking oneself into a government-approved corona-hotel requires a deference to authority and devaluing of autonomy that runs against the American grain. We have enough trouble getting folks to wear masks.
John Cochrane of Stanford’s Hoover Institution calls the expert recommendations a “smart reopening.” He also says it is unlikely to happen. Instead, we are in for a “dumb reopening,” where people tentatively resume patterns of life resembling normality until they hear of rising infections in their area and reduce social contact voluntarily, causing a decline in new cases. “There are hundreds of little behaviors each of us take that push the reproduction rate around.” Think of a turtle retreating to his shell.
It is astonishing (and frightening) to consider that, despite our technology and wealth, America seems fated to respond to the coronavirus much in the same way it responded to the Spanish influenza a century ago: stop and go, in fits and starts, a 3,007-county patchwork of closings and re-openings and more closings, where individual responsibility and self-discipline matter as much as, if not more than, bureaucratic fiat. A “dumb reopening” would not suppress the disease, but it might provide a chance to address some of the economic, social, religious, cultural, and psychological damage that the coronavirus has wrought. And, given the recent decisions by officials both Republican and Democratic, a “dumb reopening” lies ahead. Whether we like it or not.
We feared hospitals would be overwhelmed. Instead, in many states, they’re emptying out and laying off doctors and nurses.
We had to destroy the hospitals to save them.
You could be forgiven for thinking that’s the upshot of the coronavirus lockdowns that have suspended elective surgeries and generally discouraged people from going to hospitals.
Many hospitals are getting pushed near, or over, the financial edge. At a time when we feared that hospitals would get overwhelmed by a surge of patients, they have instead been emptied out. At a time when we thought medical personnel would be at a premium, they are instead being idled all over the country.
We are experiencing an epidemic that bizarrely — and in part because of the choices of policymakers — has created a surfeit of hospital beds and an excess of doctors and nurses.
Not everywhere, of course. Hospitals in New York City and parts of New Jersey have been tested to their limits. But throughout much of the country, hospitals are drastically underutilized, both because states have banned elective procedures and people have been too afraid to show up.
One reason that we didn’t want hospitals to get overrun by COVID-19 patients is that we didn’t want to crowd out everyone else needing care. But, as a deliberate choice, we’ve ended up crowding out many people needing care — even where COVID-19 surges haven’t happened and probably never will.
Drastic measures were called for when the coronavirus hit our shores and began to spread out of control, especially in urban areas particularly susceptible to the pandemic. It is understandable that we wanted hospitals to prepare for the worst, and to preserve and muster equipment necessary to safely care for infected people. Hospitals themselves can become a vector for spread of COVID-19, so keeping away people who didn’t absolutely need to show up was a reasonable impulse.
But this is a case where the cure may be really worse than the disease — or at least has created its own crisis.
Elective surgeries are a major source of revenue for hospitals, which have taken an enormous hit as they have disappeared, often in response to state orders.
West Tennessee Healthcare, based in Jackson, lost $18 million in March after the state prohibited elective surgeries, and furloughed 1,100 out of a 7,000-person staff, according to Becker’s Hospital Review. Summit Healthcare in Arizona expects as much as a 50 percent drop in revenue after the state’s ban on elective surgeries. Philadelphia-based Tower Health, also dealing with a 50 percent drop in revenue, furloughed 1,000 employees out of 14,000.
The examples go on and on and on. Even hospitals in New York State, a center for the virus, are feeling the pinch. Catholic Health and Kaleida Health in Buffalo are furloughing workers. So is Mohawk Valley Health System in Utica, Cayuga Medical Center in Ithaca, and Columbia Memorial Hospital in Hudson.
Elective surgeries aren’t necessarily what you think. As a piece in The Atlantic pointed out, they aren’t just knee replacements. They include procedures for serious illnesses such as cancer. A recent New York Times story was headline, “The Pandemic’s Hidden Victims: Sick or Dying, but Not from the Virus.” It led with the story of a Rutgers University professor who couldn’t get treatment for the recurrence of his blood cancer.
As with the lockdowns in general, it’s not clear how much of the reduced traffic in the hospitals has been the result of people changing their behavior on their own based on fear of the virus, and how much has been the result of state edicts. But it’s certainly true that the prohibitions on elective surgeries — more than 30 governors had issued some version of them as of late April — were too clumsy and sweeping, and not geographically selective enough.
Governors in some states are now loosening them up, and it’s time for other governors around the country to follow suit, except in true hot spots. In retrospect, the bans fail the cardinal rule of health care: First, do no harm.
The American people usually put their differences aside in troubling times, pull together, and keep moving forward. The COVID crisis has proven the exception. Whether it’s because it set upon us suddenly while we were unprepared or the shock that this kind of thing can still happen, we’ve been badly divided for some time.
People are frightened because no one knows for sure what’s going on. The disease data here and around the globe is suspect. The estimates that guided policymakers differ greatly from what appears to have occurred as the pandemic spread. Credible claims have been made that state and local governments are manipulating the numbers to get more money from Washington.
That may sound ghoulish but it’s not impossible. The CARES Act included a 20 percent “bonus” for Medicare reimbursements paid out for COVID-19 patients. It incentivizes sickness, leading to an outbreak of selfishness. People want money since its being handed out freely. Those who are supposed to get it are waiting for it to arrive. Those who aren’t getting any are looking for ways to get it from those who did. Some institutions that shouldn’t have gotten it are being challenged to give it back. And, when the spigots shut off suddenly last week, those who were afraid they’d run out of ready cash — including the healthcare providers now laying off staff because they can’t afford to pay them as long as the regular practice of elective medicine is on hold — are trying to get their hands on as much of it as they can.
It’s insane, but no more than the rest of what is going on. Hospitals and doctors are asking health insurance companies to front-load payments for work to be done in the future. The law of unintended consequences kicked in when governments across America ordered elective surgeries and other care be put on hiatus to keep beds and staff and personal protective equipment available for what the experts said would be a rush of COVID-19 patients so large the system would not be able to care for them all.
Now we must deal with that in addition to everything else. Yet a climate of uncertainty has taken hold as we’re probably months into this thing. We’re worried about the implications for the health of the citizenry and the health of the economy but really: How long can we go before the whole system comes crashing down?
It’s a good question. And the day of reckoning will come upon us sooner than most people think. There are lots of people calling for the marketplace to reopen. It seems sensible now that the curve looks to have been flattened. But those decisions are best left to governors and the other local officials who issued the self-quarantine orders in the first place.
The politicians in Washington keep spending money faster than they can print it to keep things liquid. The latest tranche is almost $500 billion, bringing the total to $5 trillion, give or take yet some people still haven’t been made anything close to whole. Usually, that’s not the government’s responsibility but usually, the government doesn’t shut down the economy. Like the doctors and hospital administrators and trustees who want cash upfront from the insurance companies for work they may do later, everyone wants to know what they must do to survive — if, that is, survival remains possible.
Let’s start by letting the rest of the healthcare sector get back on its normal course. Putting people back to work, allowing folks to put bread on their table and money in the bank as the byproducts of their labors is the best answer. Looking to the government to require people who have money to give it to people who don’t — which is where some folks may want this to all go — may sound appealing but it ultimately gets you to a place no American wants to be. Like Venezuela.
Obamacare may be weakened, but its chief designer, Ezekiel Emanuel, still wants to decide whether your life is worth living.
NBC News and MSNBC recently announced that Ezekiel Emanuel, the chief Obamacare architect and brother of President Obama chief of staff Rahm Emanuel, has been hired as a “medical contributor.” Presumptive Democrat presidential nominee Joe Biden has also tapped Emanuel as a health care advisor.
According to Yahoo News, he will co-host a four-part special on Lawrence O’Donnell’s “The Last Word” that will “examine the public health crisis from a variety of perspectives, including the governmental response, the strain on hospitals, the latest research into treatments and how the disease works, and the heroes — nurses, doctors and medical personnel — who are fighting COVID-19 on the front lines.” Emanuel recently told MSNBC the United States has “no choice” but to remain in lockdown for the next 18 months to fight the virus.
Now seems a good time to remember that Emanuel believes people — particularly the aged — who aren’t contributing materially to society should get out of the way for the benefit of the strong. It’s an argument that seems especially ironic at this time, given that President Trump is getting pounded by the left daily for purportedly putting the health of the economy over the well-being of the vulnerable.
Writing for The Atlantic back in 2014, Emanuel outlined the reasons he hopes to die at the age of 75. He wasn’t outright advocating euthanasia or assisted suicide, but stating his intention, when he reaches 75, to eschew any medical treatments designed to prolong his life — not only aggressive measures such as chemotherapy, but also treatments as basic as antibiotics.
His argument was a purely utilitarian one: by the time someone has reached 75, he is on the downhill slope — in mental acuity, creativity, physical strength, productivity, and ability to contribute materially to society. Rather than prolong a life that Emanuel deems of lesser quality and worth than it was at 20, 40, or 60, he plans to accelerate the arrival of death and, theoretically, compress the period of suffering that precedes death. He doesn’t want his children to go through a lengthy time of watching him decline and die, only to be left “with memories framed not by … vivacity but by … frailty.”
Shortly after Emanuel’s article was published, I wrote a response, “Why I Want to Live Long and Burden My Children,” arguing against his utilitarian view. The title was not ironic. I described the challenge of caring for my elderly mother in my home, noting that, while she wasn’t able to contribute in ways the world generally values, the “burden” of her presence was a blessing to my family in other ways, teaching us about humility, service, sacrifice, and the inherent value of life apart from its so-called usefulness.
Fast-forward five years. In January, Emanuel wrote a new article for The Atlantic in which he recounted the weeks leading up to and including his father’s recent death. After a fall, Emanuel’s 92-year-old father was diagnosed with an incurable brain tumor. Rather than seek treatment, the family decided to take him home to die in peace.
Emanuel uses the occasion of his father’s death to demonstrate the health system’s predisposition toward continuing pointless treatments rather than providing quality end-of-life care. He concludes, “A terminal diagnosis is inherently traumatic for patients and their families. My father’s experience at home before his death needs to become the standard of care. And not just for patients with pushy sons who have medical training and know how to speak with physicians, disconnect cardiac monitors, and firmly refuse the interventions that our health-care system is so predisposed to offer.”
It’s a worthwhile point. Like many, I can relate to Emanuel’s experience with his father. In 1994, my own father died of lung cancer, metastasized to his brain and liver. He previously had a leg amputated due to peripheral artery disease and was in a weakened state from that as well as from radiation for the cancer.
Once the cancer spread, the oncologist told my mom that the next step, chemotherapy, would be extremely hard on my father, with little chance of measurably extending his life. He said that, if the patient were his own father, he would not recommend it. My father, with my mother’s support, turned down further treatment.
My mother’s own end-of-life story is similar to that of Emanuel’s father. She died four years ago, after a fall followed by a hospitalization, complications, and, finally, hospice care. When it became clear that she was too tired to fight, we took her home to die in her own bed, surrounded by people who loved her.
So I am not arguing for doing anything and everything to prolong life when it’s clear that death is imminent. I am a Christian who believes that there comes a time to shift the focus from extending earthly life to preparing for the passage into eternal life.
But those looking to Emanuel for end-of-life guidance would do well to remember that he is an atheist who has not changed his view about how to approach questions of life, death, and patient care since he served as the primary designer of Obamacare. A review of his most recent interviews and writings on the topic reveals that he still holds to a utilitarian approach based on productivity and “quality” rather than one that has a high regard for all life, regardless of whether it is valued by others. In fact, he objects asmuch to the healthy senior citizen living it up in a Florida retirement community as to the one waiting to die in a nursing home because, in his view, neither is contributing meaningfully to society.
“Look at what most 82-year-olds are doing, even the ones who are mentally and physically functional,” he says. “The New York Times had this big story about the Fountain of Youth that was published just after my article. They went to some place in Arizona where they reported on this woman riding a motorcycle and this guy scuba diving, all in their 90s. Basically, those people are having fun. They’re not doing anything that is contributing new ideas, new contributions, or mentoring younger people. They are enjoying themselves. Which is great. But not if it is all of your life.”
The problem with judging the value of a life based on its “quality” or usefulness is determining who gets to decide. The child in the womb, the patient in a vegetative state, and the elderly person with dementia are not able to speak for themselves. They are weak and at the mercy of others who, however well-intentioned, cannot entirely ignore their own agendas.
Even those who are able to speak for themselves — whether healthy, disabled, or terminally ill — may be influenced by all manner of arguments based on quality, usefulness, or convenience because such arguments have been so pounded into our societal consciousness. But when we buy into them even a little bit, we unlock a door that is all too easy to throw wide open.
If we allow the child who is likely to have a low “quality” of life to be aborted at 3- or 6- or 9-months’ gestation, what is the problem with killing her, on that basis, right after birth — or even later? If an older person, whether ill or healthy, is no longer contributing what Emanuel deems to be “meaningful work,” why should the health care system help him keep going?
Then there’s that little issue of cost. Emanuel notes in his most recent article that it was much cheaper to take his father home than to continue pursuing treatment.
In a 2019 article for National Review, Wesley J. Smith cites a Journal of the American Medical Association editorial about the inevitability of health-care rationing. He notes that while the force of Obamacare has been “blunted,” the “overarching” plan of rationing is still in place, and voices like the New England Journal of Medicine continue to tout “quality of life” as one basis on which to do so.
I agree with Emanuel on one point: no matter what we do and how we try to escape death, it will come for each of us, and at some point, we have to come to terms with and prepare for it. But none of us is in a position to decide what makes a life worth living. To do so is the epitome of human arrogance. As Lutheran pastor Christopher Esget preached in a sermon before this year’s March for Life in Washington, D.C., “God makes, and we are made. He makes life, and we leave alive.”
Emanuel is now 13 years from the age that he said, in 2014, he wants to die. No doubt he considers that he is still contributing sufficiently to the universe to merit continued dependence on that universe’s resources. I wish he granted the same right of self-evaluation to everyone else, particularly as he positions himself as a voice of authority during a pandemic.
I also wish he understood that the God who created him, and who loves him whether he acknowledges it or not, has a much different gauge of his life’s value than its usefulness in this world.